The U.S. military is struggling to fill the ranks of its medical corps — while the Defense Department spends hundreds of millions of dollars annually on training and retaining its physicians, the rate of recruitment is not keeping up with the number of personnel leaving the service.

In the 2022 survey of Medical Corps officers, respondents cited pay as one of the main reasons they were considering leaving the service — there is a significant disparity between what a physician can make in the military versus what they will make in the civilian world. 

Many pointed to insufficient administrative support as the reason for considering leaving the military.

“I think everybody complains about the administrative burden, both the military and even the civilian sector. To cite that as a big reason that they might consider leaving was a bit of a surprise to me,” Ed Chan, a senior operations researcher at RAND, said.

The risk of skill degradation also prompts Medical Corps officers to separate from the military. During peacetime, military doctors often deal with routine care for healthy service members and their families, which leads to skill atrophy.

In addition, post 9/11, the Defense Department tried to lower healthcare costs by outsourcing care to civilian hospitals, which also contributed to military doctors leaving the service.

In recent years, however, the military has started placing its physicians and nurses in civilian trauma centers to help medical personnel maintain and improve their trauma care skills.

“This presents something interesting in that maybe that it’s a solution that not only is placing those physicians in the civilian hospital important for keeping their skills up, but it might also increase the chances that they decide to stay in the Army because they’re concerned that in the absence of that their skills will go,” Chan said.

Given the Army’s challenges to bring enough physicians to fill posts around its bases, the Army Office of the Surgeon General asked RAND to explore how the service could recruit enough doctors to meet their needs during peacetime as well as wartime.

“This was an interesting study in that they asked us to think outside the box. There are some very obvious things to look at, such as the actual recruiting processes that they use. Another very obvious thing to look at would have been pay. Both of those were things that the Army leadership kind of took off the table for us,” Chan said.

“They either thought that they understood those processes or thought that there was not much they could do about it. And so what they wanted us to do is think creatively outside of recruiting, outside of straight pay, about other ways of making people want to join the Army or want to stay in the Army. We were told to think outside the box, and yet we wanted to make sure we came up with things that were feasible.”

Possible in-between solutions to build medical force

One of the solutions that strikes a balance between creative and feasible is placing active-duty Army doctors in civilian hospitals, Chan said. But instead of the current model of being compensated by the Army while working at a civilian trauma center, these doctors would earn a civilian salary. This hybrid model would allow the Army to address that compensation gap while allowing its doctors to maintain their skills.

This would require the DoD to look at how many civilian hospitals would be willing to work in such an arrangement. 

“Right now, civilian hospitals are very happy to accept active-duty physicians into their hospitals. That is because it is essentially free to that hospital — the Army is paying their salary as an active duty soldier,” Chan said.

“If Army doctors were to serve in civilian hospitals and be paid by civilian hospitals, first, you have to make sure that civilian hospitals will be willing to pay them. Second, there are some legal implications of that that would have to be worked out. What does it mean when a civilian hospital is paying somebody who is in the Army?”

Another version of this idea would be a model where military doctors split their time between an Army hospital and a civilian hospital within the same week. 

While it’s not a construct that currently exists within the Defense Department, the Space Force is in the process of finalizing how Guardians can work part-time. 

“Right now, when we talk about part-time soldiers, we generally mean that the person has civilian status and does their training once a month as well as a couple of weeks a year. But generally, it’s a civilian, so it’s quite clear what they are. But when it’s quite literally half and half — it’s not clear that the system is prepared to support that right now,” Chan said.

Researchers also recommend expanding Army-sponsored Graduate Medical Education, which would improve recruitment by improving their chances of securing a spot in a desired residency.

These solutions are not quick fixes, but researchers argue there are “sufficient advantages to these courses of actions that make them worth examining and considering.”

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